Simple Strategy with Big Impact in HAC Prevention

Hospital acquired conditions (HAC) continue to be a considerable problem in healthcare.

According to a presentation from the Office of Disease Prevention and Health Promotion at this year’s APIC 2017 conference, 1 in 25 US hospital patients has at least one healthcare associated condition.

In response to this ongoing problem, hospitals are harnessing their creativity to develop innovative solutions. Among those at the forefront of these creative techniques is Helen DeVos Children’s Hospital and their Kamishibai cards.

Kamishibai cards (or K-Cards) have their origins in Japanese manufacturing, as a visual auditing method. The team at Helen DeVos Children’s Hospital has taken this simple, lean technique and transformed the cards into an easy-to-use method for HAC rounding.

An unlikely idea

The idea was born out of a problem – the team at the hospital were unable to get data out of their electronic medical record to show compliance with HAC prevention efforts.

“We knew we had to change our model of how we gathered data,” says Leslie Jurecko, Medical Director of Quality and Safet at Helen DeVos Children's Hospital, which is part of Spectrum Health.

Inspired by the K-Card method, the team created cards that included audit questions for various HAC prevention bundles (outlined by Solutions for Patient Safety), as well as follow-up details and instructions for the auditor to follow. The cards, which form a series addressing various HACs, are placed on a board in a centralized area. Frontline staff, serving as the “auditors”, select cards at random and complete audits throughout the day. The information from the audits is then carefully recorded.

When the cards were first introduced over two years ago, it was a huge undertaking. “We rolled out the cards across all our floors at the same time and focused on four HAC bundles,” says Jennifer Liedke, Patient Safety Consultant. The four initial bundles were Catheter-Associated Urinary Tract Infections (CAUTIs), Central Line-Associated Bloodstream Infections (CLABSIs), Pressure Ulcers and Falls.

And while the initial roll-out was ambitious, both Liedke and Jurecko say that the process went quite smoothly. “We learned and tweaked some of the process as we went,” says Liedke.

The roll-out process included:

Trialing cards on the units to test the content and wording

Tying the project to a broader campaign about HAC reduction

Attending staff meetings with an executive leader to introduce the project

“It really took off,” says Liedke, “People even wanted to create cards to support other initiatives they were working on.”

Meaningful impact

Over two years after the implementation of K-Carding, the process is still being widely used.

“We’ve posed the question to our units as to whether we should pull back on some cards, and both times we’ve had the discussion it’s been a resounding no,” says Liedke.

Interest in the technique has also grown – Liedke and Jurecko estimate that 50 to 75 organizations have approach them about K-Carding and have implemented it in their own hospitals.

The team at Helen DeVos Children’s Hospital have also seem measurable improvements in their HAC rates – in May 2017 the hospital reached the milestone of 365 days without a CAUTI.

However, Liedke and Jurecko are careful to point out that these milestones are a result of the hospital’s holistic approach to HACs, which includes developing multi-disciplinary teams that use the data collected by K-Card audits to inform targeted interventions.

“When you’re following a process, when you’re measuring, when you’re transparent with data – before you know it staff are on board,” says Jurecko.

Tips from the experts

For anyone intrigued by the K-Card method, Jurecko and Liedke have some tips:

Physician engagement is crucial to rolling out the process among frontline staff.

Engage your leadership to show that HACs are priorities from the top down.

Think about the readiness of your staff – that will help inform how and where you roll out the process and how many HACs you should start out targeting.